As lawmakers head home for the holidays, the Senate is poised for a critical showdown over health care in the coming weeks. The unresolved issue of enhanced Affordable Care Act (ACA) subsidies looms large, a concern that has dominated legislative discussions and triggered a record-breaking government shutdown. With the new year ushering in a shift toward electoral campaigning, the pressure to reach a resolution intensifies.

Months of intense debate have centered around the fate of these expiring subsidies, an issue that has spurred multiple votes and extensive negotiations. Despite the looming Dec. 31 deadline, a bipartisan coalition remains hopeful that an agreement can be brokered as early as next month. However, they are navigating a challenging landscape marked by divisive health care rhetoric and the impending midterm elections.

Senator James Lankford of Oklahoma succinctly captured the uphill battle ahead, reflecting on the contentious nature of health care reform since the inception of ObamaCare. “Any conversation about anything on health care has been a big lift,” he noted, acknowledging the difficulty in securing votes even when there is bipartisan recognition of existing problems. “Trying to vote on it has been tougher, so no matter what we do tweaking this thing out, it’s going to be hard,” Lankford added.

The Senate’s inability to pass two rival health care proposals on December 11 highlights the complexities involved. While both bills failed, it was notable that four Republicans broke ranks to support a Democratic initiative aimed at extending the subsidies for three more years. This cross-party collaboration has spurred efforts among senators from both sides to salvage a viable solution.

The Senate voted on two competing health care proposals on Dec. 11. Both failed — though four Republicans crossed the aisle to vote in favor of a Democratic bill to extend the subsidies for three years — and senators on both sides of the aisle have spent the days since trying to pick up the pieces and find a deal.

A group of nearly two dozen members occupying various political lanes across each party convened early last week with an eye toward unveiling a possible deal next month, with some even indicating hopes that a framework agreement could come by the end of the holiday work period. 

Sens. Susan Collins (R-Maine) and Bernie Moreno (R-Ohio) were among the organizers of the meeting. Their bill calling for a two-year extension of the subsidies paired with conservative-leaning reforms served as a basis for the discussion.

On Wednesday, a group of House GOP centrists who bucked their leadership by signing onto a Democratic effort to force a vote on extending the subsidies also met with a group of senators to try to chart a path to a deal that could pass in both chambers.

Democrats in the Senate have also shied away from tying the health care battle to the looming government funding deadline at the end of January, giving talks a boost.  

However, the Senate adjourned without a health care framework.

Democrats present for the first bipartisan meeting last week said that they were initially encouraged by the discussion but indicated that complications made striking a deal increasingly problematic.

“There was a simple concept on the table when we walked in. It was within the range of reason, but then it got more complicated. … The complicators, conceptually, might be OK [or] might not,” Sen. Tim Kaine (D-Va.) said, labeling the meeting a “productive discussion.” 

Attendees said that they expect future meetings, but whether they continue to push the ball up the field — and keep talking during the two-week holiday break — remains an open question. 

Both sides also have political considerations that could scuttle discussions at any time. 

Numerous Republicans have signaled they have little to no appetite to vote on any type of extension of the enhanced subsidies, no matter the reforms that could make the package more palatable. 

They have also indicated that language concerning the Hyde Amendment, which bars federal funds from going toward abortion in any health care package, remains a major sticking point. 

Democrats are also quick to note that Republicans have continuously opposed the ACA. The minority party has indicated they plan to pin the blame on the GOP for the premium hike that millions of Americans are set to experience in the lead-up to the midterms.

“I know that there are a lot of voices on the Democrat side that are saying, ‘We gave it a shot, now let’s move into the political season,’” said Sen. Thom Tillis (R-N.C.). “Do I think that there’s enough Democrats who genuinely want to avoid the problem that we know [is] going to occur?”

“But I’m guessing some of their political leaders … would prefer to have the issue and not the outcome,” Tillis said.

There are other considerations that could shake up negotiations. Chief among them is that four Republicans signed on to a Democratic discharge petition that tees up a vote on a plan that would extend the subsidies for three years. 

While the Senate already voted on a similar bill as part of their health care exercise earlier in the month, some Democrats believe this could give negotiations a shot in the arm when they return. 

“If the House sends something over, that puts pressure on us to do something,” Kaine said. “It’s completely different when the number of people on the [GOP] side who said to me, ‘Why would we do something if the House is just going to kill it anyway?’” 

“Well, OK — now we know that it’s not DOA in the House. When they send a bill over, that means it’s not DOA,” he said.

Kaine added that he expects members to encounter constituents back home who are paying exorbitant premiums compared with 2025. 

That, however, doesn’t mean lawmakers are optimistic that something could still get done — including at the leadership level. 

“There’s a lot of things that have to come together,” said Senate Majority Leader John Thune (R-S.D.). “I’m not saying it’s likely, and I’m not saying it’s impossible.”